Provider Demographics
NPI:1578695490
Name:TAX, JOSEPH BERNARD (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BERNARD
Last Name:TAX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-0068
Mailing Address - Country:US
Mailing Address - Phone:320-468-2379
Mailing Address - Fax:320-468-2325
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-0068
Practice Address - Country:US
Practice Address - Phone:320-468-2379
Practice Address - Fax:320-468-2325
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN88761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice